<body>
<table cellpadding="0px" cellspacing="0px" style="border-collapse:collapse;border: 1px solid #C51010;padding: 5px">
	<tr>
		<td style="border: 1px solid #FFFFFF; border-bottom:1px solid #C51010;border-left: 0px">
			<table cellpadding="0px" cellspacing="0px">
				<tr>
					<td style="background: url('red_gradient.gif'); color: #FFFFFF;padding: 3px">Girl1</td>
				</tr>
			</table>
		</td>
	</tr>
	<tr>
		<td style="padding: 10px">
			<table>
				<tr>
					<td><img src=""/></td>
				</tr>
				<tr>
					<td>question 1</td>
				</tr>
				<tr>
					<td align="left">
						<table cellspacing="0" cellpading="0">
							<tr>
								<td><input type="radio" style="margin:2;padding:0" name="rate"/>1</td>
								<td><input type="radio" style="margin:2;padding:0" name="rate"/>2</td>
								<td><input type="radio" style="margin:2;padding:0" name="rate"/>3</td>
								<td><input type="radio" style="margin:2;padding:0" name="rate"/>4</td>
								<td><input type="radio" style="margin:2;padding:0" name="rate"/>5</td>
							</tr>
						</table>
					</td>
				</tr>

				<tr>
					<td><textarea></textarea></td>
				</tr>
				<tr>
					<td><button>Save Answer</button></td>
				</tr>
			</table>
		</td>
	</tr>
</table>
</body>
